G1 Modifier, G2 Modifier, G3 Modifier, G4 Modifier, G5 Modifier, G6 Modifier

(2022) Modifier G1, G2, G3, G4, G5 & G6 – Descripions & Billing Guidelines

All hemodialysis claims must indicate the most recent Urea Reduction Ratio (URR) for the dialysis patient. Code all claims using CPT 90999 along with the appropriate G modifier listed below.

List With G Modifiers

Urea Reduction Ratio (URR) Modifiers.

G1 Modifier

Description of Modifier G1: Most recent URR of less than 60%.

G2 Modifier

Description of Modifier G2: Most recent URR of 60% to 64.9%.

G3 Modifier

Description of Modifier G3: Most recent URR of 65% to 69.9%.

G4 Modifier

Description of Modifier G4: Most recent URR of 70% to 74.9%.

G5 Modifier

Description of Modifier G5: Most recent URR of 75% or greater.

G6 Modifier

Description of Modifier G6: ESRD patient for whom less than seven dialysis sessions have been provided in a month.

Coding Guidelines

Claims for dialysis treatments must include the adequacy of hemodialysis data as measured by URR. Dialysis facilities must monitor the adequacy of dialysis treatments monthly for facility patients.

Home hemodialysis and peritoneal dialysis patients may be monitored less frequently, but not less than quarterly. 

If a home hemodialysis patient is not monitored during a month, the last, most recent URR for the dialysis patient must be reported.

CPT 90999

Description of CPT 90999: Unlisted dialysis procedure, inpatient or outpatient.

CPT 90999 must be reported in field location 44 for all bill types 72X. The appropriate G-modifier in field location 44 (HCPCS/RATES) is used, for patients that received seven or more dialysis treatments in a month.

Continue to report revenue codes CPT 0820, CPT 0821, CPT 0825, and CPT 0829 in field location 43.

For patients that have received dialysis 6 days or less in a month, facilities shall use modifier G6.

The techniques to be used to draw the pre- and post-dialysis blood urea Nitrogen samples are listed in the National Kidney Foundation Dialysis Outcomes Quality Initiative Clinical Practice Guidelines for Hemodialysis Adequacy, Guideline 8, Acceptable Methods for BUN sampling, New York, National Kidney Foundation, 2000, pp.53-60.

For additional information visit Dialysis Adequacy, Infection and Vascular Access Reporting

Reference: http://www.cms.gov/Regulations-and-Guidance/Guidance/Transmittals/Downloads/R2134CP.pdf

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